Basic Information
| Provider Information | |||||||||
| NPI: | 1265477350 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAKKOURI | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11600 W 2ND PL | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203210000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11600 W 2ND PL | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203210000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 76156 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 76156 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 76156 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | DR.0048345 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | DR.0048345 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P01524193 | 01 | CO | MEDICARE RAILROAD | OTHER | 54002231 | 05 | CO | MEDICAID | 4369232 | 05 | MI | MEDICAID |